Democrats May Limit Tax Increase for Health Plan

President Obama attended a discussion with health care workers at Children's National Medical Center in Washington, D.C., on Monday.Credit
Brendan Smialowski for The New York Times

WASHINGTON — As President Obama began a new push to overhaul the health system, Democratic Congressional leaders, bowing to unease among lawmakers and governors in their own party on Monday, suggested scaling back a plan to tax top earners to pay for the sweeping legislation and signaled a retreat from their ambitious timetable.

House and Senate leaders had been pressing for floor votes in each chamber before lawmakers depart for the August summer recess. But Congressional aides said it was increasingly clear that the Senate would not be ready to vote on its bill before its recess begins on Aug. 8, and that House Democrats seemed unwilling to vote to raise taxes without knowing where the Senate stood.

The House speaker, Nancy Pelosi, suggested revising the tax-raising provisions, one of the most contentious parts of the House bill, which would impose a surtax on high-income households. Ms. Pelosi said she would prefer that fewer people had to pay the tax, which was approved Friday by the Ways and Means Committee.

Mr. Obama, who said on Monday that he had not given up on his timetable, made clear on Tuesday that he would keep up the pressure for action. Indeed, he was scheduled to speak on the subject again from the White House early this afternoon.

“If you don’t set a deadline in this town nothing happens,” he said on NBC’s “Today” program. He again spoke dismissively of those he sees as injecting partisan politics into the issue, before adding that “I actually am optimistic” about the prospects for change.

Asked whether he favored a surtax on the wealthy to help pay for expanded care, the president implied clearly that he did. “What I’ve said is, I don’t want to see additional tax burdens put on people who are making $250,000 a year or less,” he said. “That is one option among many, but what levels that’s going to be at, where it’s pegged at, all those details are still being worked out.”

The well-off, he added, including himself in their number, should not view this approach as a sacrifice. “That’s part of being a community,” Mr. Obama said.

On Monday, while visiting the Children’s National Medical Center in Washington, the president spoke out strongly against a health system that he said was increasingly unaffordable: “If we do nothing, then families will spend more and more of their income for less and less care.”

But rather than repeating his demand that each chamber of Congress pass a health care bill before the August break, Mr. Obama emphasized the need to reach a final agreement by the end of the year. “So let’s fight our way through the politics of the moment,” he said. “Let’s pass reform by the end of this year.”

Despite White House insistence to the contrary, the end-of-year deadline suggested that Mr. Obama was backing away slightly from his timetable; previously he had called on Congress to send him legislation to sign by mid-October.

A spokesman for Ms. Pelosi, Nadeam Elshami, said she still hoped for a vote before the House adjourned on July 31.

Even as Mr. Obama sought to answer critics, the Mayo Clinic, cited by the president and lawmakers of both parties as a model, criticized the House health care bill on Monday, saying, “The legislation misses the opportunity to help create higher-quality, more affordable health care for patients.”

Under the House bill, the surtax would apply to individuals with adjusted gross incomes of more than $280,000 and couples filing joint returns with incomes over $350,000. Aides to Ms. Pelosi said she wanted to lift the thresholds to $500,000 for individuals and $1 million for joint filers, so the new levy could be described as a tax on millionaires.

The Senate, however, has shown little interest in such a tax to pay for the legislation. And House Democrats, especially more junior members elected in 2006 and 2008 from Republican-leaning districts, are reluctant to vote for a big tax increase if it is unlikely to be included in the final bill.

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Such a vote, they argue, would provide easy fodder for opponents seeking to paint them as tax-and-spend liberals. Those concerns prompted Ms. Pelosi to warn the Senate majority leader, Harry Reid of Nevada, that she might have to delay the House vote on the bill until September unless she had a clearer idea of the Senate’s plans.

Ms. Pelosi’s comments on the surtax, made initially in an interview with the Web site Politico, , came as the chairman of the House Energy and Commerce Committee met with several fiscally conservative Democrats who are worried abut the cost and scope of the health care bill.

Aides to Ms. Pelosi said Congress would not need as much revenue from the surtax if lawmakers could squeeze additional savings out of the health care system, perhaps by demanding greater concessions from private insurers and pharmaceutical companies.

The bill, projected to cost roughly $1 trillion over 10 years, would extend health coverage to 37 million people, according to an analysis issued by the Congressional Budget Office.

The chairman of the Senate Finance Committee, Senator Max Baucus, Democrat of Montana, said Monday that members of his committee had made progress in their effort to forge a bipartisan proposal. House Democrats monitoring the negotiations in the Finance Committee suggested that a deal between Mr. Baucus and the senior Republican on the panel, Charles E. Grassley of Iowa, could yield a plan to pay for the bill that would eliminate the need for the income surtax.

Mr. Grassley, in an interview Monday on MSNBC, dismissed the idea of a so-called millionaire’s tax. “Definitely that’s off the table,” he said.

Eric J. Toder, a tax economist at the Urban Institute, said that if the income thresholds for the surtax were increased to the levels suggested by Ms. Pelosi, “it would reduce the number of people affected by more than half.”

The Ways and Means Committee said the tax approved by the panel last week would apply to 1.2 percent of households and would raise $544 billion over 10 years.

“I really do not understand the politics of trying to sell health care reform, which is supposed to be for the benefit of the vast majority of Americans, and saying it should be paid for only by people making over $1 million,” Mr. Toder said. “If it’s worth doing, and I think it is, more people should be willing to pay for it.”

As Democrats seemed to ease their deadline of approving the legislation within the next two to three weeks, employer groups sent a letter to Mr. Reid, saying he should not short-circuit the work of the finance panel.

“We strongly urge you to encourage the Senate Finance Committee to continue its discussions on a bipartisan basis to reach consensus on how to improve our health care system and identify ways to expand coverage, without dramatically affecting those who do have coverage,” said the letter, signed by nine groups, including the Business Roundtable, the National Association of Manufacturers and the United States Chamber of Commerce.

Some of the sharpest criticism seemed to come from the Mayo Clinic, which has endorsed efforts to overhaul the health care system.

“Unless legislators create payment systems that pay for good patient results at reasonable costs, the promise of transformation in American health care will wither,” the clinic said.

Jeff Zeleny and Brian Knowlton contributed reporting.

A version of this article appears in print on , on Page A1 of the New York edition with the headline: OBAMA PUSHING, BUT EARLY VOTE ON HEALTH FADES. Order Reprints|Today's Paper|Subscribe